Martín Cantera Carlos, Puigdomènech Elisa, Ballvé Jose Luis, Arias Olga Lucía, Clemente Lourdes, Casas Ramon, Roig Lydia, Pérez-Tortosa Santiago, Díaz-Gete Laura, Granollers Sílvia
Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain Centre d'Atenció Primària (CAP) Passeig de Sant Joan, Institut Català de la Salut (ICS), Barcelona, Spain Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
BMJ Open. 2015 Oct 1;5(10):e008807. doi: 10.1136/bmjopen-2015-008807.
The objective of the present review is to evaluate multicomponent/complex primary care (PC) interventions for their effectiveness in continuous smoking abstinence by adult smokers.
A systematic review of randomised and non-randomised controlled trials was undertaken.
Selected studies met the following criteria: evaluated effects of a multicomponent/complex intervention (with 2 or more intervention components) in achieving at least 6-month abstinence in adult smokers who visited a PC, biochemical confirmation of abstinence, intention-to-treat analysis and results published in English/Spanish.
We followed PRISMA statement to report the review. We searched the following data sources: MEDLINE, Web of Science, Scopus (from inception to February 2014), 3 key journals and a tobacco research bulletin. The Scottish Intercollegiate Guidelines Network checklists were used to evaluate methodological quality. Data selection, evaluation and extraction were done independently, using a paired review approach. Owing to the heterogeneity of interventions in the studies included, a meta-analysis was not conducted.
Of 1147 references identified, 9 studies were selected (10,204 participants, up to 48 months of follow-up, acceptable methodological quality). Methodologies used were mainly individual or group sessions, telephone conversations, brochures or quit-smoking kits, medications and economic incentives for doctors and no-cost medications for smokers. Complex interventions achieved long-term continuous abstinence ranging from 7% to 40%. Behavioural interventions were effective and had a dose-response effect. Both nicotine replacement and bupropion therapy were safe and effective, with no observed differences.
Multicomponent/complex interventions in PC are effective and safe, appearing to achieve greater long-term continuous smoking cessation than usual care and counselling alone. Selected studies were heterogeneous and some had significant losses to follow-up. Our results show that smoking interventions should include more than one component and a strong follow-up of the patient to maximise results.
本综述的目的是评估多成分/复杂初级保健（PC）干预措施对成年吸烟者持续戒烟的有效性。
对随机和非随机对照试验进行系统综述。
所选研究符合以下标准：评估多成分/复杂干预措施（有2个或更多干预成分）对到初级保健机构就诊的成年吸烟者实现至少6个月戒烟的效果、戒烟的生化确认、意向性分析以及以英文/西班牙文发表的结果。
我们遵循PRISMA声明报告该综述。我们检索了以下数据来源：MEDLINE、科学网、Scopus（从创刊到2014年2月）、3种主要期刊以及一份烟草研究简报。使用苏格兰校际指南网络清单评估方法学质量。采用配对评审方法独立进行数据选择、评估和提取。由于纳入研究中干预措施的异质性，未进行荟萃分析。
在识别出的1147篇参考文献中，选择了9项研究（10204名参与者，长达48个月的随访，方法学质量可接受）。所采用的方法主要是个体或小组会议、电话交谈、宣传册或戒烟工具包、药物以及对医生的经济激励措施和为吸烟者提供免费药物。复杂干预措施实现的长期持续戒烟率为7%至40%。行为干预有效且具有剂量反应效应。尼古丁替代疗法和安非他酮疗法均安全有效，未观察到差异。
初级保健中的多成分/复杂干预措施有效且安全，似乎比单纯的常规护理和咨询能实现更高的长期持续戒烟率。所选研究具有异质性，一些研究有显著的失访情况。我们的结果表明，吸烟干预措施应包括不止一个成分，并对患者进行有力的随访以最大化效果。
